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Alert Number 309


Date: December 18, 2008

I will be the first to admit lack of familiarity with many of the complementary therapies that are of interest to cancer patients.  Among them, the traditional Chinese practice of acupuncture.  “Acupuncture is being used in the palliative care of cancer patients, to alleviate pain” says Dr. Cassileth in this guest editorial from MSKCC.  While the exact mechanism of how acupuncture works is still debated, I am all for pain remediation.  There is no merit in patients being in pain, if it can be controlled safely.  Does acupuncture work better than opiates such as Vicodin? Does it have fewer side effects? Is it less addictive?  Clearly, there are advantages to a non-drug based palliative measures if they help patients deal better with pain.  For that reason, these are all important questions to discuss with your doctors.

What caught my eye, and the reason why I chose to write this Alert, is the list of contraindications at the end of the editorial.   Neutropenia (low neutrophil counts), thrombocytopenia (low platelet counts), risk of infection and lymphedema (compromised lymphatic system: ) are all listed as contra-indications for acupuncture.  Most if not all CLL patients have one or more of these contra-indicators – especially the bit about risk of infection.  Just a word to the wise - your call, you are the boss.

Be well,


December 1, 2008



Lawrence S. Rockefeller Chair in Integrative Medicine
Memorial Sloan-Kettering Cancer Center, New York, New York

For additional information visit the Memorial Sloan-Kettering Cancer Center Integrative Medicine Service free website, “About Herbs” at

Integrative Oncology is the synthesis of mainstream care and nonpharmacologic, evidence-based complementary therapies for the control of cancer-related physical and emotional symptoms. This month, we explore the ancient Chinese practice of acupuncture, which is widely used in the palliative care of cancer patients.

DR. CASSILETH: Acupuncture is an important component of traditional Chinese medicine. The practice originated more than 2,000 years ago. It involves stimulation of one or more predetermined points on the body with sterile, filiform, disposable needles, sometimes with added heat (moxibustion), pressure (acupressure) or electricity to enhance therapeutic effect. The needles are much thinner than the hypodermic needles used for injections.

The ancient theory underlying acupuncture assumes that “qi” (pronounced “chee”), or life energy flows through vertical energy channels called meridians, which were thought to connect the internal organs. It was believed that disease occurs when the meridians become blocked. Acupuncture was thought to relieve the blockage and permit the normal flow of qi, thereby restoring health.

Acupuncture is being used in the palliative care of cancer patients, to alleviate pain and a variety of treatment side effects. It is generally safe when performed by trained practitioners and is well tolerated by patients, including children.

Some conditions require continuous treatments in order to achieve long-term effect. Cancer patients considering acupuncture should seek certified or state-licensed practitioners who have training or experience in working with cancer patients. —Barrie Cassileth, PhD

USES: To treat various symptoms associated with cancer and cancer treatment, including pain, fatigue, nausea and vomiting, depression, constipation, xerostomia, hot flashes, and neuropathy.

MECHANISMS: Although some acupuncture points coincide with pressure-sensitive trigger points, indicating enriched enervation at the anatomic location, biophysiologic and imaging research indicates that acupuncture can induce analgesia and activate the central nervous system.[1] Mechanisms remain an active topic of investigation.

RESEARCH: The World Health Organization supports the use of acupuncture as an effective intervention for lower back pain, postoperative pain, and adverse reactions to radiotherapy and chemotherapy.[2] A 1997 Consensus Conference at NIH concluded that acupuncture is effective in relieving pain, nausea, and osteoarthritis. Since that conference, a large research literature has expanded the evidence for additional benefits, and NIH continues to support clinical trials of acupuncture.

Current data support the use of acupuncture for chronic headache, chronic neck pain, chronic prostatitis/pelvic pain, and symptoms associated with fibromyalgia. In addition, studies show benefits against peripheral neuropathy[3] and a variety of other conditions. The role of acupuncture for symptom control in cancer is now well established, with substantial data supporting its ability to alleviate pain,[4] chronic fatigue, postoperative and chemotherapy-induced nausea and vomiting, and xerostomia.[5] Data from a recent randomized, placebo-controlled trial at Memorial Sloan-Kettering Cancer Center with 70 head and neck cancer patients confirmed the usefulness of acupuncture for pain and dysfunction as well as for xerostomia following head and neck surgery.[6]

CONTRAINDICATIONS: Neutropenia, thrombocytopenia, or history of endocarditis (acupuncture may increase risk of infection and bleeding); pregnancy (pregnant women should inform practitioners before seeking acupuncture treatment); lymphedema (needles should not be placed in lymphedematous limbs); pacemakers and other electronic medical devices.

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